Diagnosis Of Carcinoma Cuniculatum Research Articles

Carcinoma Cuniculatum Masquerading as Eumycetoma: An Unacquainted Entity Posing a Diagnostic Dilemma.

Carcinoma cuniculatum (CC) is a rare and distinct clinicopathological variant of well-differentiated squamous cell carcinoma. It is a rare and slow-growing tumor with a peculiar infiltrative growth pattern resembling rabbit burrows (cuniculi). It usually occurs over the plantar aspect of the foot but can also occur at other sites like the oral cavity and genitals. The pathogenesis is unknown, with various hypotheses of trauma as proposed by different authors. It is essential to be aware of this entity as it commonly mimics benign and other low-grade squamous cell carcinoma (SCC). Diagnosis of CC can be challenging and requires repeated histological evaluation and clinical correlation. Herein, we present a case report of CC of the plantar and dorsal aspect of the foot in a 60-year-old male with a history of multiple chronic non-healing ulcers, which was clinically suspected as eumycetoma and remained inconclusive on numerous biopsies.

Mandibular Carcinoma Cuniculatum around the Dental Implant in a Patient with Concurrent Management for Pemphigus Vulgaris: A Case Report

Background: Carcinoma cuniculatum (CC) is a rare subtype of squamous cell carcinoma that is difficult to diagnose owing to the lack of cellar atypia and/or associated oral epithelial dysplasia. The prognosis is good given proper resection, but it often has a poor prognosis with recurrence. We present the case of a 78-year-old man who visited our department with an ulcer around the implant in tooth 35. With Nikolsky’s phenomenon in the gingiva, a detailed examination revealed pemphigus vulgaris. Steroid administration remarkably improved the oral symptoms but caused osteomyelitis and rapid bone destruction, leading to pathological fracture. After multiple biopsies, mandibular segment resection was performed with a diagnosis of mandibular osteomyelitis, and no malignant findings were found. Four months later, the wound reopened, a white keratinized lesion appeared, and a biopsy revealed CC. Unresectable tumor infiltration was already observed, but the patient died of aspiration pneumonia 15 months after diagnosis. Conclusions: It took 20 months to make a definitive diagnosis of CC in this case. Pemphigus vulgaris may have made the diagnosis particularly difficult. Since other CCs are often diagnosed with osteomyelitis or odontogenic keratocyst preoperatively, we recommend keeping in mind the possibility of CC in refractory cases.

CYSTIC SQUAMOUS CELL CARCINOMAS OF THE JAWS: TWELVE CASES HIGHLIGHTING HISTOPATHOLOGIC PITFALLS

<h3>Background and Objective</h3> Cystic squamous cell carcinomas (SCC) of the jaws, including carcinoma cuniculatum (CCu), are rare, slow-growing, and relentlessly invasive. The aim of this study is to document 12 cases. <h3>Methods</h3> Review of patient hospital notes, histopathologic reports, and original histologic sections. <h3>Results</h3> Six patients were female and 6 were male (mean age = 74.0 years; range, 50-94). Six tumors affected the mandible and 6 affected the maxillary alveolus with or without extension into the hard palate. Clinical presentation varied, ranging from relatively innocuous-looking ulceration to a grossly ulcerated mass, with radiological evidence of bony destruction in all cases. One patient had multiple dysplastic lesions and was retrospectively diagnosed with proliferative verrucous leukoplakia. For 2 others the tumor was a second primary oral SCC. Histologically, 4 of the 12 tumors were designated as CCu on the basis of deeply endophytic, anastomosing channels of cystic stratified squamous epithelium and keratin microabscesses. The other 8 were also cystic but more heterogeneous morphologically, and though a diagnosis of CCu had been considered in 5 of the 8 cases the final diagnosis was well-differentiated SCC. All patients underwent primary resection with neck dissection and were staged as T4a N0 M0. None developed any notable postoperative complications, but 4 patients died between 6 and 57 months after surgery. In 4 patients diagnosis was delayed as a result of superficial biopsies and/or confusing histopathology. <h3>Conclusions</h3> Cystic SCC of the jaws can be difficult to diagnose histologically. Clinico-radiological correlation and long-term follow-up are essential.

CARCINOMA CUNICULATUM: IMPORTANCE OF CLINICOPATHOLOGIC CORRELATION

A 56-year-old male was referred for evaluation of tooth mobility and bone destruction in the anterior mandible. The patient was submitted to removal of tooth 34 three months before. Medical history revealed no alcohol, tobacco intake, or any systemic disease. The clinical examination showed mobility of teeth 33 and 35 and the presence of an infiltrative lesion associated with white plaques in the gingiva and alveolar mucosa of the region. The panoramic and periapical radiographs showed irregular bone destruction in the region of teeth 33 and 35. Clinical diagnosis was squamous cell carcinoma, and an incisional biopsy was performed. Histologic analysis of the specimen was compatible with carcinoma cuniculatum. The patient was submitted for surgical resection of the lesion, and the analysis of the surgical specimen confirmed the diagnosis of carcinoma cuniculatum. The patient has been under clinical and radiographic follow-up for 4 months without evidence of local recurrence.

SYNCHRONIC CARCINOMAS CUNICULATUM IN THE MAXILLA - A CASE REPORT

Carcinoma cuniculatum (CC) is a rare malignant neoplasm. A 66-year-old female patient presented with asymptomatic gingival swelling in the left maxilla associated with whitish pasty secretion with 3-month duration. The patient denied smoking habits and alcohol consumption and reported a recent surgical procedure in the region. At extraoral examination, there were no palpable lymph nodes. Intraoral examination revealed multiple papules in the posterior vestibular gingiva. Incisional biopsy was performed, and the histopathologic diagnosis was CC. The treatment consisted of surgical resection. After 2 months, the patient presented a swelling in the anterior region of the palatal mucosa, with secretion drainage similar to keratin. The biopsy was performed, and the histopathologic examination also rendered the diagnosis of CC. After excision, the affected area was submitted to 33 section of intensity-modulated radiation therapy (IMRT) accounting for 66 Gy. The patient remains under follow-up with no signs of recurrence.

Carcinome cuniculatum : une tumeur orale inhabituelle

We report on a case of carcinoma cuniculatum (CC) of the maxillary gingival mucosa. A 60-year-old woman presented with an exophytic gingivo-palatal mass with slow growth and osteolytic evolution. A first performed biopsy was negative for malignancy. The diagnosis of CC was established on the surgical representative biopsy. CC is a rare low-grade variant of squamous cell carcinoma that is usually found in the foot or in oral cavity. The pathognomonic microscopic feature of CC is an endo- and/or exophytic lesion composed by a well differentiated squamous epithelium infiltrating into underlying stroma forming a complex pattern of keratin cores and keratin filled "rabbit warren" crypts. CC is a locally evolutive carcinoma with a usually good prognosis usually without lymph node or distant metastatic evolution.

Gingival carcinoma cuniculatum mimicking a reactive/inflammatory process

ABSTRACT Carcinoma cuniculatum (CC), a rare variant of oral squamous cell carcinoma, presents well-differentiated neoplastic epithelial cells infiltrating the underlying submucosal or bone tissues, forming the so-called rabbit burrows filled with keratin. A 67-year-old female patient was referred complaining of a painless tumoral mass in the left mandibular body, with several months of evolution. Previous history indicated extraction of the teeth #37 and #38 and diagnosis of chronic suppurative osteomyelitis. A deep incisional biopsy revealed CC. Due to its microscopic features, suggesting an inflammatory or reactive process, strict clinicopathological correlation is necessary for the correct diagnosis of CC.

Carcinoma Cuniculatum of the Esophagus and Tongue: Report of Two Cases, Including TP53 Mutational Analysis

Carcinoma cuniculatum (CC) is a rare variant of extremely well differentiated squamous cell carcinoma. We present the clinicopathological features of two cases of CC; one lingual and one esophageal case with a molecular genetic study regarding the TP53 gene mutational status. Case 1 was a 62year old male with enlarging chronic ulcer in the tongue. Case 2 was a 77year old male with progressive dysphagia and odynophagia. Both patients were treated surgically. Both tumors showed deeply invaginating, keratin-filled, burrowing crypts lined by very well differentiated squamous epithelium. The esophageal tumor showed varying degrees of reactive nuclear atypia largely limited to the areas with dense intratumoral infiltration of neutrophils. No mutation of TP53 was identified in the esophageal case. Cytologic atypia limited to areas of significant acute inflammation may occur in CC and should, in the absence of aggressive stromal invasion, not preclude a diagnosis of CC.